Malignant Solitary Fibrous Tumor of the Hypopharynx With Dysphagia

Abstract

S olitary fibrous tumors are rare spindle cell neoplasms that are most commonly within the thorax, especially the pleura. The first case of this tumor arose in 1931 involving the pleura, 1 and it has since been recognized to occur in a large variety of sites. In the past 15 years, solitary fibrous tumors have been recognized in many new sites in the body. Relevant to the field of otolaryngology, this includes the epiglottis, larynx, parapharyngeal space, paranasal sinus, thyroid, and nasopharynx. Once thought to be of mesothelial origin (they still are described as mesotheliomas at times), most experts have agreed that solitary fibrous tumors are instead mesenchymal neoplasma, not just limited to mesothelial surfaces. This explains their presence in the head and neck and their ubiquitous status in the human body. Although by no means a common occurrence, solitary fibrous tumors are becoming increasingly recognized as more physicians become aware of their presentation.

Solitary Fibrous Tumor of the Postcricoid Region: A Case Report and Literature Review

“…Two authors have previously reported hypopharyngeal SFTs, but both originated from the pyriform sinus [2, 3]. All three cases (including the present case) of SFT of the hypopharynx occurred in men.…”

“…Our patient presented with progressive shortness of breath leading him to seek treatment, and the mass could be seen encroaching on the laryngeal inlet. Mussak et al reported that their patient, although not reporting dyspnea, had a near occlusion of the airway by the hypopharyngeal mass [2]. This has also been described in cases presenting in the larynx.…”

“…The ages at diagnosis were between 32 and 58, and the average was 45. Presenting symptoms were related to the mass effect of the tumor and included dysphonia, dyspnea, a feeling of tightness in the chest, dysphagia, and weight loss [2, 3]. SFT in other locations has been demonstrated to cause hypoglycemia secondary to IGF-2 production, but this has not been demonstrated in the hypopharynx [8].…”

“…Metastasis has been described to the lungs, bone, and liver but is very rare [10]. In the hypopharynx, there have been two reported benign cases and one histologically malignant case that was not associated with any local or distant invasion [2, 3]. …”

“…SFT has been described in almost every organ in the human body, but presentation in the hypopharynx is extremely rare, with only two previously reported cases [2, 3]. We present the first case of SFT ever reported in the English literature originating from the postcricoid region of the hypopharynx.…”